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Storm of criticism of staff may not be helpful


from the Royal New Zealand College of General Practitioners

5 December 2007

Storm of criticism of staff may not be helpful

The attack of the “name, shame, blame” culture enveloping Wellington Hospital is likely to be counter-productive, believes the leading promoter of quality practice in primary care, the Royal New Zealand College of General Practitioners.

Instead, the College of GPs believes the formula to obtaining and sustaining a quality clinical environment is:

- Having standards agreed by those who use them, rather than having them imposed

- Having a comprehensive organisational commitment to continuously seek quality improvements

- Accepting that sometimes things go wrong, and having mechanisms in place to learn from these events – particularly tragic ones.

“Experience shows that blaming one person, for what is a ‘system’ failure will only drive problems underground, with errors hidden,” says College president Dr Jonathan Fox, whose own Meadowbank (Auckland) practice holds Cornerstone accreditation.

Medical care, he points out, is never 100 per cent sure of success. People are different, and their bodies may react differently to treatments. Some procedures carry more risk.

The College of GPs has just been successful in obtaining Government funding for every general practice to go through its Cornerstone accreditation programme.

Cornerstone requires general practices to have a ‘Significant Events Management” log recording not only major events that went well, but incidents, accidents, complaints and ‘sentinel events’ – those that have a significant effect on the patient, resulting in permanent disability and death. The log becomes the catalyst for analysis and for learning.

The College’s 2002 publication Significant Events Management notes that “errors can be expected, even from good people in the best organisations. SEM takes a ‘no-blame’, systems approach to examining error. The analysis focuses on how and why the defences failed rather than who failed.”

“Change in the defences then reduces the likelihood of accidents occurring,” Dr Fox said. And people learn from the mistakes.

The whole Cornerstone programme is based around standards for general practice developed by GPs, practice nurses and practice managers.

As part of the College’s mission to improve the health of all New Zealanders, one of this country’s leading researchers in primary care, Associate Professor Susan Dovey is currently working to produce a proactive comprehensive strategy on patient safety in primary care.

“Health care has become so complex that all systems must work well, particularly communication,” Professor Dovey said.


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